1760483002 NPI number — MS. DIANE GRIFFITHS PECK CNM

Table of content: MS. DIANE GRIFFITHS PECK CNM (NPI 1760483002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760483002 NPI number — MS. DIANE GRIFFITHS PECK CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PECK
Provider First Name:
DIANE
Provider Middle Name:
GRIFFITHS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760483002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 COLUMBIA ROAD
Provider Second Line Business Mailing Address:
UPHAMS CORNER HEALTH CENTER
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-740-8000
Provider Business Mailing Address Fax Number:
617-740-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 COLUMBIA ROAD
Provider Second Line Business Practice Location Address:
UPHAMS CORNER HEALTH CENTER
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-740-8000
Provider Business Practice Location Address Fax Number:
617-740-8060
Provider Enumeration Date:
08/09/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  NM172899 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)